title: Patient characteristics and outcomes in metastatic upper tract urothelial carcinoma after radical nephroureterectomy: the experience of Japanese multi-institutions.
abstract: OBJECTIVE
  To investigate oncological outcomes and prognostic factors in patients with upper tract urothelial carcinoma (UTUC) who experienced disease recurrence after radical nephroureterectomy (RNU). Few studies have focused on the clinical courses of patients who experienced disease recurrence after RNU.
  
  
  METHODS
  A total of 204 UTUC patients who experienced disease recurrence from a retrospective multi-institutional cohort were included in the present study. Associated patient outcomes were analyzed using multivariate analysis.
  
  
  RESULTS
  The mean time from RNU to first disease recurrence was 15.0 months and ≈90% of patients experienced disease recurrence within the first 3 years after RNU. During a median follow-up of 8.1 month after disease recurrence, 165 patients died from UTUC and five patients died from other causes. In the 204 cohorts, 1- and 3-year cancer-specific survival rates were 40.2% and 9.7%, respectively, and 1- and 3-year overall survival rates were 39.5% and 9.4%, respectively. After disease recurrence, 132 patients underwent systemic chemotherapy, and a subgroup analysis of patients who underwent systemic chemotherapy multivariate analysis showed that performance status, the presence of liver metastasis and the number of recurrence sites were independently prognostic of cancer-specific and overall survival after relapsing. According to three significant variables, 1- and 3-year cancer-specific survival rates were 72.7% and 20.8% in patients with no risk factors, 46.5% and 7.5% in patients with one risk factor, and 26.4% and 4.4% in patients with two or three risk factors, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Most patients died from UTUC within 3 years, even though systemic chemotherapies were administered after relapsing. Multivariate analysis showed that performance status, the presence of liver metastasis and the number of recurrence sites were independently related to poor survival after systemic chemotherapy.
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Kent
authors.initials: K
authors.lastname: Kanao
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ide
authors.forename: Jun
authors.initials: J
authors.lastname: Obata
authors.forename: Katsura
authors.initials: K
authors.lastname: Hoshino
authors.forename: Suguru
authors.initials: S
authors.lastname: Shirotake
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Momma
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000368:Aged; D044466:Asian People; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000601:surgery*; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality / Q000601:surgery*